Clinical Presentation: Manifestation of Multiple Sclerosis Across Life

This essay provides an overview of three clinical presentations commonly diagnosed in individuals aged 18-25: multiple sclerosis (MS), depression, and anxiety. It summarizes each condition, highlighting the differences in their symptoms and effects. The essay then focuses on multiple sclerosis, detailing its manifestation across a person's lifespan, including the initial clinical presentation, diagnostic methods (blood test, evoked potential test, lumbar puncture, and MRI), changes in presentation over time, allopathic treatments (steroid drugs, injectable and oral drugs), and discipline-specific approaches. It further discusses the prognosis of MS, expected outcomes for patients, and factors to consider in managing the condition, noting the impact on quality of life and the potential for secondary disorders and reduced lifespan. The essay emphasizes the importance of rehabilitation programs and support for individuals with MS.

Running head: CLINICAL PRESENTATION
Clinical presentation
Name of student
Course
University
Date
Lecturer

CLINICAL PRESENTATION 2
Ailments
Introduction
One way or another, we tend to be struck by various ailments, which force us to spend
heavily. In this essay, I will look into three clinical presentations and mainly focus on one
particular clinical presentation. They are multiple sclerosis, depression and anxiety. In the
three presentations, there is a slight difference between them. Multiple sclerosis is a chronic
disease that affects the central nervous system while depression is a psychiatric disorder,
which affects a person mentally according to American Psychiatric Association (2013).
Depression (2015) says that, depression on the other hand is a psychiatric disorder that affects
a person mentally. It affects people of all ages. As a youth, one undergoes a lot in his or her
life. This technological era is bound to pressurize a person due to the heavy influence of the
internet. All in all, as a youth, it depends whether you are at work, home or school.
According to Elder (2018), in such a state, one tends to act weird. Some loved ones
and friends may isolate you in such a state. There are many factors which may cause one to
be depressed. Such as being laid off from your job, losing a child, losing a loved one etc.
Notably, it is prevalent among older adults since they are in a state of denial. They fail to
admit their guilt or sadness towards a situation.
This disorder needs to be handled with care since such individuals are prone to
anything. Depending on their moods, they may covey mixed feelings and a person needs to
understand such people. In other cases, they may show reckless behaviour and anger. It has
been noted that depression occurs more often in women than men. These differences have
been based on sex and age. All in all, the youth experience their feelings differently. Some
may develop recurrent thoughts of suicide while others may be prone to anger.

CLINICAL PRESENTATION 3
There are medications one can take to ease depression despite no cure. If it is
discovered early, one can be rehabilitated early. The healing process takes time since one will
undergo a lot of therapy. Most people associate it with being mad but that isn’t the case. It is
a mental condition which makes one act differently. It is advisable to take such an individual
for treatment or in certain rehabilitation homes. Support is heavily recommended since such
an individual is undergoing a lot in his or her life.
Moreover, there is a distinct difference between depression and anxiety disorder. This
is evident in their primary symptoms which starts with the mental symptoms. When a person
experiences anxiety disorders, he or she is apprehensive on what is to happen and in the
future. He or she develops worried thoughts that something could go wrong. There is also a
feeling like you need to run away from situations that could cause further anxiety.
Both anxiety and depression disorder are similar due to changes in
neurotransmitter function especially serotonin. Anxiety disorder can be brought about by
factors of depression. They both correlate together. As a youth who is depressed, such
feelings may creep in and this may lead to diverse effects unto an individual. Moreover,
people who undergo depression often experience symptoms alike to anxiety disorder. Such as
nervousness, irritability and problems in sleeping and concentrating. However, it depends on
the type of disorder since they vary on their causes and symptoms.
Multiple sclerosis (MS)
Multiple sclerosis refers to the disorder that affects the spinal cord and the brain of
an individual this is according to Kelley (2015). When one is attacked with this disease, he or
she may have some problems such as the communication problems. The reason why

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communication problem comes in is that the myelin of the patient is attacked by the immune
system. The attack causes a disconnection between the rest of the body of the individual and
the brain. As the time goes, the patient experiences deterioration in the nerve system.
However, the changes in every patient differ according to the type of multiple sclerosis that
has attacked the person. In most cases, there are 3 types of this disorder in reference to Lader
(2015). The first type of the disorder is the primary progressive multiple sclerosis. This type
of disorder makes steady changes of the patient and causes more disabilities than the rest.
One ailment leads to another. When an individual is diagnosed with multiple
sclerosis, he or she is prone to depression in reference to Baer (2015). Anxiety on the other
hand is a state in which you develop negative thoughts brought about by depression. Anxiety
comes in once a person is depressed. Individuals within that age group may experience it
differently. The youth are the most affected category as they are prone to lots of things.
Drugs, relationships and other things enable one to be in such a state according to Calabresi
et al 2014.
Cooney & Mead (2014) says that, multiple sclerosis is a chronic disease which
affects the central nervous system. It tends to develop slowly within the central nervous
system. Notably, over 400,000 people in the United States have Multiple sclerosis and around
10,000 cases are diagnosed each year. It has certain features like:
 It affects the central nervous system.
 Its diagnosis is usually between the ages of 20-50 years.
 No cure has been found yet but treatment can be done via certain drugs
recommended by the doctor.
 Its symptoms vary depending on whether it’s mild or severe.

CLINICAL PRESENTATION 5
Furthermore, in a research published by the Journal of Neurology,
Neurosurgery and Psychiatry, children diagnosed with Multiple Sclerosis took longer to
develop secondary progressive disease than adults diagnosed with multiple sclerosis in
reference to Costa et al. (2016). Interestingly, Multiple sclerosis in children typically
progresses more slowly than one diagnosed in adulthood. Unfortunately, children diagnosed
with the ailment tend to be disabled at a young age according to Dendrou et al. (2014).
Moreover, it can develop at any age. Its symptoms are fatigue, difficulty in
walking, blurred vision, muscle stiffness, itching or respiratory problems etc. These
symptoms occur in stages depending on how far your illness has progressed. This particular
age group is the worst hit by this ailment. If discovered early, various measures can be put
into place to control it. Currently, initiatives have come up to conduct clinical trials in
children with Multiple Sclerosis in reference to Spain et al. (2017). This is so as to better
understand effective treatment options in this age group.
There are various drugs recommended for this ailment. Corticosteroids is the
most commonly prescribed drugs. This is because it reduces inflammation and supresses the
immune system. It mostly treats an acute flare-up of symptoms in certain types of Multiple
Sclerosis. Other drugs are prescribed as well. Such as Interferon Beta 1a or 1b, Copaxone,
Tysabri etc. Notably, this ailment is prevalent among the youth. There has been no cure so far
of this ailment.
Thus, an individual suffering from this ailment is advised to be rehabilitated.
One undergoes various programs like physical therapy, occupational therapy and many more.
It helps in healing a lot.
However, it is uncommon in many instances. The second type is the relapsing-
remitting multiple sclerosis. When one is attacked by this type of MS, the changes that take

CLINICAL PRESENTATION 6
place in the body of the individual is unpredictable. The changes include the exacerbations,
acute diseases, and some other non-recovery defects. On the other hand, the changes in the
individual do not worsen too much compared to the other types of the disorder. The last type
of MS is the relapse MS. This type of the disorder attacks the fatty sheaths of the nerve fibres
according to Lassmann (2018). The individual may also develop a plaque in the brain.
Current allopathic treatment of MS
As stated earlier in the assignment, there are around three types of multiple
sclerosis according to Mahad et al. (2015). The existence of the three types of multiple
sclerosis means that there are different ways of treating the type of the MS. Before the doctor
begins any treatment, several test and diagnosis are done to the patient. However, up to date,
there is no specific treatment for multiple sclerosis; there is management procedure that the
doctor can recommend. The doctor undertakes several tests such the blood test, evoked
potential test, lumbar puncture and lastly the MRI test in reference to Lublin et al (2014).
When doing the blood test, the medical practitioner establishes is there are any symptoms of
the blood that is associated with multiple sclerosis. On the other hand, lumbar puncture
analyses the fluid in the brain and the spinal cord. By doing this test, the doctor may find out
some specific antibodies that are related to MS. MS mostly affect the brain and the spinal
cord that is why doctor takes the fluid from the particular places. The evoked test finds out
and analyses the electrical signals that the nervous system produces. On the last part, the MRI
test checks the status of the brain to reveal any signs of MS.
Current discipline-specific treatment
When it comes to the treatment of each type of MS, this assignment begins with the
multiple sclerosis relapses according to Montalban et al. (2017). After several diagnoses that
the doctor would have done to the patient, he or she may recommend the best treatment. The

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first possible treatment is the injecting the patient with steroid drugs for three to five
consecutive days. However, the other suggestion is giving the tablet steroid tablets that he or
she is going to take for five days. The steroid drugs do not permanently treat relapse MS but
the reduce any other complications. There is no specific treatment for most types of MS.
However, there exist some options such as the injectable drugs. The drugs include the Rebif,
Octavia, and Avonex among others. On the other hand, there exist oral drugs such as the
fingolimod, teriflunomide among other drugs. These drugs reduce the effect of the disease on
the individual in reference to Moutsianas et al.(2017) The disease is not cured permanently
but the drugs reduce any further complications.
The prognosis of MS
Nolen-Hoeksema & Rector (2015) says that, most patients who have
experienced this disorder experience difficulty in walking. In future, it seems that out of four
patients, two of them will require walking support from the people around him. On the other
hand, some patients who suffer from this disorder end up committing suicide. Apart from
that, it is evident that the deaths that arise from MS patient come because of the secondary
disorder. These disorders include the chronic infections, difficulty in breathing and
swallowing of food. The defects of MS causes severe pain to the patient and therefore it is
important for the patient to avoid some daily activities. When the rate of death of people
suffering from the disorder is compared with other people, these patients mostly die seven
years earlier than the rest of the population in reference to Sadock and Ruiz (2013). The type
of MS that the individual is suffering from mainly determines the course of MS. For instance,
the relapsing MS have different prognosis compared to the rest of the disorder. In many
instances, the doctors have difficulty in determining whether the symptoms of any type of
MS disorder will worsen or not. The standard of life patients of MS live is always of low
quality and it is important for them to adjust to any upcoming condition.

CLINICAL PRESENTATION 8
Expected outcomes for patients during the lifespan
The people living with MS disorder should be aware several complications during
their lifespan according to Posavac & Posavac (2017). The first thing is that their life will
reduce in terms of its quality. The reason behind that is that MS comes with several
complications that alter the way their lives operate. Another important thing the patient needs
to know is that the complication is not a certificate of death; however, there are some several
ways in which the disorder can be maintained. There are some severe symptoms that may
also affect the patient named earlier in the assignment according to Segal et al.(2018).
Consequently, if the patient was a working class, he or she should be aware of their rights.
Lastly, the patient will always live shorter as compared to the rest of the people.
Studies compiled in the US show that the youth are prone to these disorders.
Separation issues, huge amount of pressure from your boss, truancy among others. What
people fail to understand is their distinct difference. The possible treatment for this ailment is
by taking medication. There have been varying probable causes of this disorder but none has
been fully identified. Most studies have been linked with other factors which still remain a
mystery. Furthermore, various theories have been formulated but none is clear yet in
reference to Gilbert (2016).

CLINICAL PRESENTATION 9
References
American Psychiatric Association(2013).Diagnostic and statistical manual of mental
disorders(5th ed). Arlington, VA: American Psychiatric Publishing
Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to
evidence base and applications. Elsevier.
Calabresi, P. A., Radue, E. W., Goodin, D., Jeffery, D., Rammohan, K. W., Reder, A. T., ...
& Li, B. (2014). Safety and efficacy of fingolimod in patients with relapsing-remitting

CLINICAL PRESENTATION 10
multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled,
phase 3 trial. The Lancet Neurology, 13(6), 545-556.
Cooney, G., Dwan, K., & Mead, G. (2014). Exercise for depression. Jama, 311(23), 2432-
2433.
Costa, J., Marôco, J., Pinto‐Gouveia, J., Ferreira, C., & Castilho, P. (2016). Validation of the
psychometric properties of the Self‐Compassion Scale. Testing the factorial validity
and factorial invariance of the measure among borderline personality disorder, anxiety
disorder, eating disorder and general populations. Clinical psychology &
psychotherapy, 23(5), 460-468.
Dendrou, C. A., Fugger, L., & Friese, M. A. (2015). Immunopathology of multiple
sclerosis. Nature Reviews Immunology, 15(9), 545.
Depression, P. (2015). Heterogeneity of postpartum depression: a latent class analysis. The
Lancet Psychiatry, 2(1), 59-67.
Elder, G. H. (2018). Children of the great depression. Routledge.
Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge.
https://www.nimh.nih.gov/health/publications/depression/index.shtml#pub1
Kelley, R. D. (2015). Hammer and hoe: Alabama communists during the great depression.
UNC Press Books.
Lader, M. (2015). Generalized anxiety disorder. In Encyclopedia of
Psychopharmacology (pp. 699-702). Springer Berlin Heidelberg.
Lassmann, H. (2018). Multiple sclerosis pathology. Cold Spring Harbor perspectives in
medicine, 8(3), a028936.

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Laube. Justin-How age affects multiple sclerosis symptoms and progression-Retrieved from
www.everydayhealth.com/multiple-sclerosis/symptoms
Lublin, F. D., Reingold, S. C., Cohen, J. A., Cutter, G. R., Sørensen, P. S., Thompson, A.
J., ... & Bebo, B. (2014). Defining the clinical course of multiple sclerosis The 2013
revisions. Neurology, 83(3), 278-286.
Mahad, D. H., Trapp, B. D., & Lassmann, H. (2015). Pathological mechanisms in progressive
multiple sclerosis. The Lancet Neurology, 14(2), 183-193.
Montalban, X., Hauser, S. L., Kappos, L., Arnold, D. L., Bar-Or, A., Comi, G., ... & Lublin,
F. (2017). Ocrelizumab versus placebo in primary progressive multiple sclerosis. New
England Journal of Medicine, 376(3), 209-220.
Moutsianas, L., Jostins, L., Beecham, A. H., Dilthey, A. T., Xifara, D. K., Ban, M., ... &
Attfield, K. E. (2015). Class II HLA interactions modulate genetic risk for multiple
sclerosis. Nature genetics, 47(10), 1107.
Nolen-Hoeksema, S., & Rector, N. A. (2015). Abnormal psychology. Boston: McGraw-Hill.
Nordqvist.C-Multiple sclerosis:What you need to know- Retrieved from
www.medicalnewstodaay.com/articles/37556.php
Posavac, S. S., & Posavac, H. D. (2017). Adult Separation Anxiety Disorder Symptomology
and Susceptibility to Marketing Persuasion. Journal of Social and Clinical
Psychology, 36(2), 158-169.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2018). Mindfulness-based cognitive
therapy for depression. Guilford Publications.

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Spain, D., Sin, J., Harwood, L., Mendez, M. A., & Happé, F. (2017). Cognitive behaviour
therapy for social anxiety in autism spectrum disorder: a systematic review. Advances
in Autism, 3(1), 34-46.
Retrieved from www.calmclinic.com/anxiety/difference-anxiety-depression
Sadock. Badock, V.A, and Ruiz, P. (2013).Comprehensive Textbook of Psychiatry (Ninth
edition).
Retrieved from Junomedical.com- 6 Ways You can help an Older Adult with Depression